page 15 (counselling 2)
Sometimes a woman is blackmailed by her friend or husband. He
will leave her if she does not terminate the pregnancy, and although
she wants to keep the child she yields to the threat. You may react
indignantly and state that she should be glad to get rid of the
fellow but never forget that the prospect to be left is so terrifying
for most women that they will give in.
It also happens that a woman does not decide to abort hoping that
the pregnancy may bind the man to her. This is one of the commonest
reasons for a request to terminate an advanced pregnancy. The man
keeps telling her that she must terminate the pregnancy and she keeps
refusing till he actually leaves her.
If a young girl is pregnant she does not know what to do and so
she does nothing. The parents find out that she is pregnant when it
is too late. If a young girl is asked whether she wants to have the
baby she may says yes. She sees the baby as a live doll. The mother
rightly states that she will be the one to care for the child. So the
principle that the woman must want the termination without outside
influence needs some consideration in very young children.
Never rebuke a woman because she did not practice contraception.
Try to find out why not. Save contraceptive advice till after the
procedure. Before she is too anxious to be treated to pay much
attention. Never reprove a patient for repeated abortion. Assure her
that she will always be treated, even if it is the tenth time, but
promise her that after the procedure you will have a further word
with her on contraception.
Many women express fears when they come. Very few believe the
terrifying stories of Pro Life fanatics and their disgusting ways to
intimidate pregnant women are too unrealistic to be taken seriously.
However, some women are scared. Although their fears should be
discussed seriously, an occasional mild ridicule may help.
- A patient says that she has heard that so many women die
during an abortion. With a compassionate face the counsellor
answers: 'O yes, and such a nuisance it is. We hardly know where
to leave all those corpses'. After which the patient can laugh
about the absurdness of her statement.
Explain carefully what is going to happen. Tell the woman that
the procedure does not damage her uterus and that she may feel
natural cramps like those experienced during a heavy period or after
childbirth. These cramps are caused by uterine contractions which
facilitate the procedure. The doctor can always interrupt the
procedure on her request to administer an additional pain killing
injection. Assure her that complications are very rare and that she
runs virtually no risk of becoming sterile. Many women ask if they
can become pregnant again, often as a sort of mitigation of the
termination ('I can always make it good by becoming pregnant later').
Tell her that shortly after the procedure she is able to travel home
again and that in almost all cases she may resume work the next day.
Counseling after the procedure may be done while the patient is
still in bed, it may be done privately or in a small group of women.
I prefer the last option. Not only is it time sparing, it also gives
rise to a discussion where questions are answered which other women
did not think of. And women find out that their problems are more
common than they thought.
Explain the course after treatment: she may feel slight abdominal
pains which are proof that the uterus is actively contracting and
thus preventing blood loss and infection. Give her a few pain killing
tablets of the antiprostaglandinetype, for instance ibuprofen. Blood loss is generally slight or
absent at all, but in almost all cases a short period like bleeding
occurs after the third day. This bleeding is not to be considered a
real menstrual period, but an effect of the hormonal changes
following the termination. Tell her that bed rest is not advised
because it may prevent proper contractions of the uterus. Urge her to
prevent infections. She must not allow anything to enter the vagina.
No intercourse, no tampons, no swimming or bathtub bathing, but
showers are allowed. Tell her to come back or seek medical advice if
anything happens that may be a complication: heavy blood loss,
prolonged blood loss (more than a week), dull abdominal pain, fever
higher than 38°. A temperature of about 38° for a few days
is normal after a termination.